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Durotomy

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https://www.readbyqxmd.com/read/27922581/pseudomeningocele-aspiration-and-blood-patch-effectively-treats-positional-headache-associated-with-post-operative-lumbosacral-pseudomeningocele
#1
Stephen Sandwell, Kevin Walter, Per-Lennart Westesson
STUDY DESIGN: Retrospective chart review with limited prospective follow-up survey. OBJECTIVE: To evaluate the efficacy and safety of blood patch injection for the treatment of positional headaches caused by postoperative lumbosacral pseudomeningoceles. SUMMARY OF BACKGROUND DATA: Pseudomeningocele is one of the most common complications after posterior lumbosacral spinal surgery. Common treatments include bedrest, abdominal binder use, subarachnoid lumbar drainage, and surgical re-exploration for durotomy closure...
December 2, 2016: Spine
https://www.readbyqxmd.com/read/27853662/postoperative-cerebrospinal-fluid-leak-rates-with-subfascial-epidural-drain-placement-after-intentional-durotomy-in-spine-surgery
#2
Tianyi Niu, Derek S Lu, Andrew Yew, Darryl Lau, Haydn Hoffman, David McArthur, Dean Chou, Daniel C Lu
Study Design Retrospective chart review. Objective Postoperative cerebrospinal fluid (CSF) leak is a known complication of intraoperative durotomy. Intraoperative placement of subfascial epidural drains following primary dural repair has been proposed as a potential management strategy to prevent formation of CSF cutaneous fistula and symptomatic pseudomeningocele. Here we describe our experience with subfascial drain after intentional durotomy. Methods Medical records of patients who underwent placement of subfascial epidural drains during spinal procedures with intentional intraoperative durotomies over a 4-year period at two institutions were retrospectively reviewed...
December 2016: Global Spine Journal
https://www.readbyqxmd.com/read/27815027/teratoma-of-the-spinal-cord-in-an-adult-report-of-a-rare-case-and-review-of-the-literature
#3
Richard F Schmidt, James P Casey, Ashish R Gandhe, Mark T Curtis, Joshua E Heller
Teratomas of the spinal cord are incredibly rare, comprising less than 0.5% of all spinal cord tumors. These tumors are exceptionally rare in adults, with only a handful of cases reported in the literature. We present the case of a 49-year-old gentleman with new onset urinary incontinence who presented with a large intradural tumor of the thoracolumbar spine. The patient underwent a laminectomy with midline durotomy for subtotal tumor resection. Surgical pathology diagnosed the tumor as a mature teratoma, exhibiting the presence of all three germ layers...
November 1, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27765561/impact-of-parkinson-s-disease-on-perioperative-complications-and-hospital-cost-in-multilevel-spine-fusion-a-population-based-analysis
#4
Shearwood McClelland, Joseph F Baker, Justin S Smith, Breton G Line, Thomas J Errico, Christopher P Ames, R Shay Bess
Parkinson's disease (PD) is a neurodegenerative disorder manifesting over time to result in reduced mobility. The impact of PD on spinal fusion has yet to be addressed on a nationwide level. The Nationwide Inpatient Sample (NIS) from 2001 to 2012 was used for analysis. Admissions with spinal fusion of two or more vertebrae (ICD-9 codes=81.62, 81.63 and 81.64) were included and then stratified based on the presence or absence of PD (ICD-9 code=332.0); patients with cancer (ICD-9 codes=140-239) or trauma (ICD-9 codes=805...
October 17, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27753786/primary-versus-revision-spinal-fusion-in-children-an-analysis-of-74-525-cases-from-the-nationwide-inpatient-sample
#5
Rafael De la Garza Ramos, C Rory Goodwin, Taylor Purvis, Isaac O Karikari, Amer F Samdani, Daniel M Sciubba
STUDY DESIGN: Retrospective cohort study of a nationwide database. OBJECTIVE: To compare in-hospital outcomes for pediatric patients who underwent primary versus revision spinal fusion. SUMMARY OF BACKGROUND DATA: There is limited data on outcomes after primary versus revision spinal fusion in children. METHODS: Data from the Nationwide Inpatient Sample from 2002 to 2011 was analyzed. Pediatric patients (age <18) who underwent ≥ 3 level spinal fusion were identified...
October 6, 2016: Spine
https://www.readbyqxmd.com/read/27742512/variability-in-standard-outcomes-of-posterior-lumbar-fusion-determined-by-national-databases
#6
Jacob R Joseph, Brandon W Smith, Paul Park
OBJECTIVE: National databases are used with increasing frequency in spine surgery literature to evaluate patient outcomes. The differences between individual databases in relationship to outcomes of lumbar fusion are not known. We evaluated the variability in standard outcomes of posterior lumbar fusion between the University HealthSystem Consortium (UHC) database and the Healthcare Cost and Utilization Project National Inpatient Sample (NIS). METHODS: NIS and UHC databases were queried for all posterior lumbar fusions (ICD-9 81...
October 11, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27683692/comparison-of-surgical-outcomes-after-anterior-cervical-discectomy-and-fusion-does-the-intra-operative-use-of-a-microscope-improve-surgical-outcomes
#7
Owoicho Adogwa, Aladine Elsamadicy, Elizabeth Reiser, Cole Ziegler, Kyle Freischlag, Joseph Cheng, Carlos A Bagley
BACKGROUND: The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. METHODS: One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data...
March 2016: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/27660177/subarachnoid-hemorrhage-and-spinal-subdural-hematoma-due-to-acute-csf-hypotension
#8
Christopher S Graffeo, Avital Perry, Eelco F M Wijdicks
BACKGROUND: Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery. METHODS: Case report...
September 22, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/27636866/effects-of-early-surgical-decompression-on-functional-and-histological-outcomes-after-severe-experimental-thoracic-spinal-cord-injury
#9
Devesh Jalan, Neginder Saini, Mohammad Zaidi, Alexandra Pallottie, Stella Elkabes, Robert F Heary
OBJECTIVE In acute traumatic brain injury, decompressive craniectomy is a common treatment that involves the removal of bone from the cranium to relieve intracranial pressure. The present study investigated whether neurological function following a severe spinal cord injury improves after utilizing either a durotomy to decompress the intradural space and/or a duraplasty to maintain proper flow of cerebrospinal fluid. METHODS Sixty-four adult female rats (n = 64) were randomly assigned to receive either a 3- or 5-level decompressive laminectomy (Groups A and B), laminectomy + durotomy (Groups C and D), or laminectomy + duraplasty with graft (Group E and F) at 24 hours following a severe thoracic contusion injury (200 kilodynes)...
September 16, 2016: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/27584677/the-true-cost-of-a-dural-tear-medical-and-economic-ramifications-of-incidental-durotomy-during-lumbar-discectomy-in-elderly-medicare-beneficiaries
#10
Varun Puvanesarajah, Hamid Hassanzadeh
STUDY DESIGN: Retrospective database review. OBJECTIVE: To identify whether dural tears increase costs and the risk of wound complications and serious adverse events during the postoperative period following primary lumbar discectomy in elderly Medicare beneficiaries. SUMMARY OF BACKGROUND DATA: Rates of incidental durotomy during lumbar spine surgery range from 1 to 17%. The full economic and medical burden of this complication remains unclear, particularly as it occurs during lumbar discectomy in elderly patients...
August 31, 2016: Spine
https://www.readbyqxmd.com/read/27559461/utility-of-discography-as-a-preoperative-diagnostic-tool-for-intradural-lumbar-disc-herniation
#11
Tomiya Matsumoto, Hiromitsu Toyoda, Hidetomi Terai, Sho Dohzono, Yusuke Hori, Hiroaki Nakamura
Preoperative definitive diagnosis of intradural lumbar disc herniation (ILDH) is difficult despite the availability of various neuroradiological investigative tools. We present a case of ILDH diagnosed preoperatively by discography and computed tomography-discography (disco-CT).The patient was a 63-year-old man with acute excruciating right leg pain. Discography and disco-CT demonstrated leakage of the contrast medium into the intradural space. Based on these findings, a right L5 nerve root disturbance caused by ILDH was diagnosed...
August 2016: Asian Spine Journal
https://www.readbyqxmd.com/read/27554306/perifascial-areolar-tissue-graft-for-spinal-dural-repair-with-cerebrospinal-fluid-leakage-case-report-of-novel-graft-material-radiological-assessment-technique-and-rare-postoperative-hydrocephalus
#12
Ken Matsushima, Ryo Hashimoto, Masahide Gondo, Hirokazu Fukuhara, Michihiro Kohno, Hiroyuki Jimbo
BACKGROUND: Incidental durotomy is a relatively common complication in spinal surgeries, and treatment of persistent cerebrospinal fluid (CSF) leakage is still challenging, especially in cases for which "watertight" suturing is inapplicable. The usefulness of a nonvascularized perifascial areolar tissue (PAT) graft recently was emphasized for plastic and skull base surgeries. Its hypervascularity allows for early engraftment and long-term survival, and its flexibility is advantageous in fixing defects of complex shapes in limited surgical spaces...
August 21, 2016: World Neurosurgery
https://www.readbyqxmd.com/read/27519623/the-dural-repair-using-the-combination-of-polyglycolic-acid-mesh-and-fibrin-glue-and-postoperative-management-in-spine-surgery
#13
Soichiro Masuda, Shunsuke Fujibayashi, Bungo Otsuki, Hiroaki Kimura, Masashi Neo, Shuichi Matsuda
BACKGROUND: Accidental dural tears are iatrogenic complications during spine surgery. However, there is no established intraoperative method or postoperative management in this situation. To examine the efficacy of the intraoperative method of dural repair, which consists of using the combination of a polyglycolic acid (PGA) mesh and fibrin glue, and the postoperative management of accidental dural tear or intended durotomy. METHODS: Seventy-five patients (34 males and 41 females; age range, 16-80 years; mean age, 57...
September 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
https://www.readbyqxmd.com/read/27441176/transforaminal-full-endoscopic-lumbar-discectomy-in-obese-patients
#14
Jun Seok Bae, Sang-Ho Lee
BACKGROUND: Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients...
2016: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/27437022/repair-of-inaccessible-ventral-dural-defect-in-thoracic-spine-double-layered-duraplasty
#15
Dong-Hyun Lee, Kyoung-Tae Kim, Jeong-Ill Park, Ki-Su Park, Dae-Chul Cho, Joo-Kyung Sung
We propose a double layered (intradural and epidural patch) duraplasty that utilizes Lyoplant and Duraseal. We examined a 47-year-old woman after decompression for thoracic ossification of posterior longitudinal ligament was performed in another hospital. On postoperative day 7, she complained of weakness in both legs. Postoperative magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) collection with cord compression. In the operative field, we found 2 large dural defects on the ventral dura mater...
June 2016: Korean Journal of Spine
https://www.readbyqxmd.com/read/27433407/application-of-the-flexible-co2-laser-in-minimally-invasive-laminectomies-technical-note
#16
Namath S Hussain, Mick Perez-Cruet
Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group's operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results...
2016: Curēus
https://www.readbyqxmd.com/read/27402228/spinal-subdural-abscess-following-laminectomy-for-symptomatic-stenosis-a-report-of-2-cases-and-review-of-the-literature
#17
Alexander D Ramos, John D Rolston, Grant E Gauger, Paul S Larson
BACKGROUND Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery...
2016: American Journal of Case Reports
https://www.readbyqxmd.com/read/27379827/minimally-invasive-subpial-tonsillectomy-for-chiari-i-decompression
#18
Jeffrey S Beecher, Yong Liu, Xiaoming Qi, Paolo A Bolognese
BACKGROUND: A number of different surgical techniques have been used through the years to address Chiari I malformation (CMI). METHODS: This article describes how we surgically manage CMI at two high-volume centers. We call the technique the minimally invasive subpial tonsillectomy (MIST). The technique consists of a minimalistic dissection and craniectomy with a short, linear durotomy for the subpial tonsillar resection. The dura is closed without the use of a duraplasty...
September 2016: Acta Neurochirurgica
https://www.readbyqxmd.com/read/27355740/watertight-sealing-without-lumbar-drainage-for-incidental-ventral-dural-defect-in-transthoracic-spine-surgery-a-retrospective-review-of-53-cases
#19
Sang-Hyeop Jeon, Sang-Ho Lee, Yi Sheng Tsang, Tag-Geun Jung, Ki-Hyoung Moon, Gun Choi, Ketan Deshpande
STUDY DESIGN: A retrospective review. OBJECTIVES: To evaluate the therapeutic efficacy of the triple layer closure technique to establish watertight sealing without diversion of lumbar drainage, in preventing persistent incidental subarachnoid-pleural fistula and other neurologic complications related to excessive drainage of cerebrospinal fluid (CSF) after dural defect in transthoracic ossified posterior longitudinal ligament (OPLL) surgery. SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid (CSF) leakage into the pleural cavity leads to unfavorable conditions for natural healing of incidental durotomy due to the negative pressure environment of the pleural space and lack of wound healing around the bony cavity near the decompressed spinal cord...
June 28, 2016: Clinical Spine Surgery
https://www.readbyqxmd.com/read/27355713/suture-choice-in-lumbar-dural-closure-contributes-to-variation-in-leak-pressures-experimental-model
#20
George M Ghobrial, Christopher M Maulucci, Matthew J Viereck, Sara Beygi, Ameet Chitale, Srinivas Prasad, Jack Jallo, Joshua Heller, Ashwini D Sharan, James S Harrop
STUDY DESIGN: Open-label Laboratory Investigational Study; Non-animal Surgical Simulation OBJECTIVES:: The authors perform a comparison of dural closure strength in a durotomy simulator across two different suture materials. SUMMARY OF BACKGROUND DATA: Incidental durotomy leading to persistent cerebrospinal fluid (CSF) leak adds considerable morbidity to spinal procedures, often complicating routine elective lumbar spinal procedures. Using an experimental durotomy simulation, the authors compare the strength of closure using Gore-tex™ with other suture types and sizes, using various closure techniques...
June 28, 2016: Clinical Spine Surgery
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